A healthcare acquisition that exposed how much financial complexity hides in payor mix: a dermatology practice with $1.8 million in annual revenue, purchased for $1.1 million by a physician who'd never owned a practice. The practice had three dermatologists, a strong reputation in the community, and what looked like stable revenue. The financing was 70% bank debt (medical-practice lending is a specialized market), 10% seller note, and 20% equity. The episode focuses on how the previous owner had been accepting all insurance plans—Medicare, Medicaid, commercial insurance, and self-pay—without actively managing the payor mix. Post-close, the new owner discovered that 35% of revenue came from Medicaid, which reimbursed at rates 40% below commercial insurance. When she tried to reduce Medicaid patient volume, existing patients became angry, and the practice's reputation suffered. Additionally, the previous owner had been billing for procedures that the new owner's compliance review flagged as potentially problematic—not fraudulent, but aggressive enough that insurance companies began denying claims at higher rates. The new owner had to invest in a compliance officer ($80,000 annually) and a billing consultant ($50,000 annually) to fix the payor mix and billing practices. The hosts examine why healthcare acquisitions require specialized due diligence around payor mix, how to identify aggressive billing practices before closing, and why the previous owner's financial statements can hide the true profitability of a medical practice.